|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,116.00
|
|
|
Service Code
|
HCPCS 49653
|
| Min. Negotiated Rate |
$1,246.40 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Aetna Medicare |
$1,558.00
|
| Rate for Payer: BCBS Complete |
$1,246.40
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,025.40
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 49654
|
| Min. Negotiated Rate |
$1,128.40 |
| Max. Negotiated Rate |
$1,833.65 |
| Rate for Payer: Aetna Medicare |
$1,410.50
|
| Rate for Payer: BCBS Complete |
$1,128.40
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.65
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 49320
|
| Min. Negotiated Rate |
$320.78 |
| Max. Negotiated Rate |
$914.55 |
| Rate for Payer: Aetna Commercial |
$429.85
|
| Rate for Payer: Aetna Medicare |
$320.78
|
| Rate for Payer: BCBS Complete |
$562.80
|
| Rate for Payer: BCBS MAPPO |
$320.78
|
| Rate for Payer: BCN Medicare Advantage |
$320.78
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Cofinity Commercial |
$429.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.78
|
| Rate for Payer: Healthscope Commercial |
$384.94
|
| Rate for Payer: Healthscope Whirlpool |
$384.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.82
|
| Rate for Payer: Nomi Health Commercial |
$384.94
|
| Rate for Payer: PACE SWMI |
$320.78
|
| Rate for Payer: PHP Medicare Advantage |
$320.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health Medicare |
$320.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.78
|
| Rate for Payer: UHC Medicare Advantage |
$320.78
|
| Rate for Payer: UHCCP DNSP |
$320.78
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: ASR ASR |
$1,364.79
|
| Rate for Payer: ASR Commercial |
$1,364.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.56
|
| Rate for Payer: BCN Commercial |
$1,090.85
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Healthscope Commercial |
$1,407.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,364.79
|
| Rate for Payer: Mclaren Commercial |
$1,266.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,238.16
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: Aetna Medicare |
$5,690.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: ASR ASR |
$1,364.79
|
| Rate for Payer: ASR Commercial |
$1,364.79
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.19
|
| Rate for Payer: BCN Commercial |
$1,090.85
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$1,407.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,364.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$1,266.30
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$6,259.14
|
| Rate for Payer: PHP Medicaid |
$3,049.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.81
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$986.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,238.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$8,819.70
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP DNSP |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$320.78 |
| Max. Negotiated Rate |
$914.55 |
| Rate for Payer: Aetna Commercial |
$429.85
|
| Rate for Payer: Aetna Medicare |
$320.78
|
| Rate for Payer: BCBS Complete |
$562.80
|
| Rate for Payer: BCBS MAPPO |
$320.78
|
| Rate for Payer: BCN Medicare Advantage |
$320.78
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Cofinity Commercial |
$429.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.78
|
| Rate for Payer: Healthscope Commercial |
$384.94
|
| Rate for Payer: Healthscope Whirlpool |
$384.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.82
|
| Rate for Payer: Nomi Health Commercial |
$384.94
|
| Rate for Payer: PACE SWMI |
$320.78
|
| Rate for Payer: PHP Medicare Advantage |
$320.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health Medicare |
$320.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.78
|
| Rate for Payer: UHC Medicare Advantage |
$320.78
|
| Rate for Payer: UHCCP DNSP |
$320.78
|
|
|
PR LAPS ABLTJ RENAL MASS LESION W/INTRAOP US
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 50542
|
| Min. Negotiated Rate |
$846.00 |
| Max. Negotiated Rate |
$1,600.36 |
| Rate for Payer: Aetna Commercial |
$1,489.22
|
| Rate for Payer: Aetna Medicare |
$1,111.36
|
| Rate for Payer: BCBS Complete |
$846.00
|
| Rate for Payer: BCBS MAPPO |
$1,111.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,111.36
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cofinity Commercial |
$1,600.36
|
| Rate for Payer: Cofinity Commercial |
$1,489.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,111.36
|
| Rate for Payer: Healthscope Commercial |
$1,333.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,333.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,166.93
|
| Rate for Payer: Nomi Health Commercial |
$1,333.63
|
| Rate for Payer: PACE SWMI |
$1,111.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,111.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.75
|
| Rate for Payer: Priority Health Medicare |
$1,111.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,111.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,111.36
|
| Rate for Payer: UHCCP DNSP |
$1,111.36
|
|
|
PR LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1
|
Professional
|
Both
|
$1,869.00
|
|
|
Service Code
|
HCPCS 38572
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$1,239.48 |
| Rate for Payer: Aetna Commercial |
$1,153.40
|
| Rate for Payer: Aetna Medicare |
$860.75
|
| Rate for Payer: BCBS Complete |
$747.60
|
| Rate for Payer: BCBS MAPPO |
$860.75
|
| Rate for Payer: BCN Medicare Advantage |
$860.75
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cofinity Commercial |
$1,239.48
|
| Rate for Payer: Cofinity Commercial |
$1,153.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.75
|
| Rate for Payer: Healthscope Commercial |
$1,032.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.79
|
| Rate for Payer: Nomi Health Commercial |
$1,032.90
|
| Rate for Payer: PACE SWMI |
$860.75
|
| Rate for Payer: PHP Medicare Advantage |
$860.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,214.85
|
| Rate for Payer: Priority Health Medicare |
$860.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$860.75
|
| Rate for Payer: UHC Medicare Advantage |
$860.75
|
| Rate for Payer: UHCCP DNSP |
$860.75
|
|
|
PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$3,833.00
|
|
|
Service Code
|
HCPCS 44227
|
| Min. Negotiated Rate |
$1,533.20 |
| Max. Negotiated Rate |
$2,491.45 |
| Rate for Payer: Aetna Commercial |
$2,137.21
|
| Rate for Payer: Aetna Medicare |
$1,594.93
|
| Rate for Payer: BCBS Complete |
$1,533.20
|
| Rate for Payer: BCBS MAPPO |
$1,594.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,594.93
|
| Rate for Payer: Cash Price |
$3,066.40
|
| Rate for Payer: Cash Price |
$3,066.40
|
| Rate for Payer: Cofinity Commercial |
$2,296.70
|
| Rate for Payer: Cofinity Commercial |
$2,137.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,594.93
|
| Rate for Payer: Healthscope Commercial |
$1,913.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,913.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,674.68
|
| Rate for Payer: Nomi Health Commercial |
$1,913.92
|
| Rate for Payer: PACE SWMI |
$1,594.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,594.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,491.45
|
| Rate for Payer: Priority Health Medicare |
$1,594.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,594.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,594.93
|
| Rate for Payer: UHCCP DNSP |
$1,594.93
|
|
|
PR LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS
|
Professional
|
Both
|
$6,309.00
|
|
|
Service Code
|
HCPCS 44211
|
| Min. Negotiated Rate |
$2,002.34 |
| Max. Negotiated Rate |
$4,100.85 |
| Rate for Payer: Aetna Commercial |
$2,683.14
|
| Rate for Payer: Aetna Medicare |
$2,002.34
|
| Rate for Payer: BCBS Complete |
$2,523.60
|
| Rate for Payer: BCBS MAPPO |
$2,002.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,002.34
|
| Rate for Payer: Cash Price |
$5,047.20
|
| Rate for Payer: Cash Price |
$5,047.20
|
| Rate for Payer: Cofinity Commercial |
$2,883.37
|
| Rate for Payer: Cofinity Commercial |
$2,683.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,002.34
|
| Rate for Payer: Healthscope Commercial |
$2,402.81
|
| Rate for Payer: Healthscope Whirlpool |
$2,402.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,102.46
|
| Rate for Payer: Nomi Health Commercial |
$2,402.81
|
| Rate for Payer: PACE SWMI |
$2,002.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,002.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,100.85
|
| Rate for Payer: Priority Health Medicare |
$2,002.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,002.34
|
| Rate for Payer: UHC Medicare Advantage |
$2,002.34
|
| Rate for Payer: UHCCP DNSP |
$2,002.34
|
|
|
PR LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST
|
Professional
|
Both
|
$4,661.00
|
|
|
Service Code
|
HCPCS 44208
|
| Min. Negotiated Rate |
$1,864.40 |
| Max. Negotiated Rate |
$3,029.65 |
| Rate for Payer: Aetna Commercial |
$2,525.47
|
| Rate for Payer: Aetna Medicare |
$1,884.68
|
| Rate for Payer: BCBS Complete |
$1,864.40
|
| Rate for Payer: BCBS MAPPO |
$1,884.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,884.68
|
| Rate for Payer: Cash Price |
$3,728.80
|
| Rate for Payer: Cash Price |
$3,728.80
|
| Rate for Payer: Cofinity Commercial |
$2,713.94
|
| Rate for Payer: Cofinity Commercial |
$2,525.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,884.68
|
| Rate for Payer: Healthscope Commercial |
$2,261.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,261.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,978.91
|
| Rate for Payer: Nomi Health Commercial |
$2,261.62
|
| Rate for Payer: PACE SWMI |
$1,884.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,884.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,029.65
|
| Rate for Payer: Priority Health Medicare |
$1,884.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,884.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,884.68
|
| Rate for Payer: UHCCP DNSP |
$1,884.68
|
|
|
PR LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$6,262.00
|
|
|
Service Code
|
HCPCS 44212
|
| Min. Negotiated Rate |
$1,933.44 |
| Max. Negotiated Rate |
$4,070.30 |
| Rate for Payer: Aetna Commercial |
$2,590.81
|
| Rate for Payer: Aetna Medicare |
$1,933.44
|
| Rate for Payer: BCBS Complete |
$2,504.80
|
| Rate for Payer: BCBS MAPPO |
$1,933.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,933.44
|
| Rate for Payer: Cash Price |
$5,009.60
|
| Rate for Payer: Cash Price |
$5,009.60
|
| Rate for Payer: Cofinity Commercial |
$2,784.15
|
| Rate for Payer: Cofinity Commercial |
$2,590.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,933.44
|
| Rate for Payer: Healthscope Commercial |
$2,320.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,320.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,030.11
|
| Rate for Payer: Nomi Health Commercial |
$2,320.13
|
| Rate for Payer: PACE SWMI |
$1,933.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,933.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.30
|
| Rate for Payer: Priority Health Medicare |
$1,933.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,933.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,933.44
|
| Rate for Payer: UHCCP DNSP |
$1,933.44
|
|
|
PR LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST
|
Professional
|
Both
|
$4,592.00
|
|
|
Service Code
|
HCPCS 44207
|
| Min. Negotiated Rate |
$1,737.08 |
| Max. Negotiated Rate |
$2,984.80 |
| Rate for Payer: Aetna Commercial |
$2,327.69
|
| Rate for Payer: Aetna Medicare |
$1,737.08
|
| Rate for Payer: BCBS Complete |
$1,836.80
|
| Rate for Payer: BCBS MAPPO |
$1,737.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,737.08
|
| Rate for Payer: Cash Price |
$3,673.60
|
| Rate for Payer: Cash Price |
$3,673.60
|
| Rate for Payer: Cofinity Commercial |
$2,501.40
|
| Rate for Payer: Cofinity Commercial |
$2,327.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,737.08
|
| Rate for Payer: Healthscope Commercial |
$2,084.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,084.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,823.93
|
| Rate for Payer: Nomi Health Commercial |
$2,084.50
|
| Rate for Payer: PACE SWMI |
$1,737.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,737.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,984.80
|
| Rate for Payer: Priority Health Medicare |
$1,737.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,737.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,737.08
|
| Rate for Payer: UHCCP DNSP |
$1,737.08
|
|
|
PR LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 44206
|
| Min. Negotiated Rate |
$1,672.02 |
| Max. Negotiated Rate |
$3,078.40 |
| Rate for Payer: Aetna Commercial |
$2,240.51
|
| Rate for Payer: Aetna Medicare |
$1,672.02
|
| Rate for Payer: BCBS Complete |
$1,894.40
|
| Rate for Payer: BCBS MAPPO |
$1,672.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,672.02
|
| Rate for Payer: Cash Price |
$3,788.80
|
| Rate for Payer: Cash Price |
$3,788.80
|
| Rate for Payer: Cofinity Commercial |
$2,407.71
|
| Rate for Payer: Cofinity Commercial |
$2,240.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,672.02
|
| Rate for Payer: Healthscope Commercial |
$2,006.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,006.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,755.62
|
| Rate for Payer: Nomi Health Commercial |
$2,006.42
|
| Rate for Payer: PACE SWMI |
$1,672.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,672.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,078.40
|
| Rate for Payer: Priority Health Medicare |
$1,672.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,672.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,672.02
|
| Rate for Payer: UHCCP DNSP |
$1,672.02
|
|
|
PR LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM
|
Professional
|
Both
|
$4,199.00
|
|
|
Service Code
|
HCPCS 44205
|
| Min. Negotiated Rate |
$1,283.47 |
| Max. Negotiated Rate |
$2,729.35 |
| Rate for Payer: Aetna Commercial |
$1,719.85
|
| Rate for Payer: Aetna Medicare |
$1,283.47
|
| Rate for Payer: BCBS Complete |
$1,679.60
|
| Rate for Payer: BCBS MAPPO |
$1,283.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,283.47
|
| Rate for Payer: Cash Price |
$3,359.20
|
| Rate for Payer: Cash Price |
$3,359.20
|
| Rate for Payer: Cofinity Commercial |
$1,848.20
|
| Rate for Payer: Cofinity Commercial |
$1,719.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,283.47
|
| Rate for Payer: Healthscope Commercial |
$1,540.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,540.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,347.64
|
| Rate for Payer: Nomi Health Commercial |
$1,540.16
|
| Rate for Payer: PACE SWMI |
$1,283.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,283.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,729.35
|
| Rate for Payer: Priority Health Medicare |
$1,283.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,283.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,283.47
|
| Rate for Payer: UHCCP DNSP |
$1,283.47
|
|
|
PR LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$5,282.00
|
|
|
Service Code
|
HCPCS 44210
|
| Min. Negotiated Rate |
$1,688.07 |
| Max. Negotiated Rate |
$3,433.30 |
| Rate for Payer: Aetna Commercial |
$2,262.01
|
| Rate for Payer: Aetna Medicare |
$1,688.07
|
| Rate for Payer: BCBS Complete |
$2,112.80
|
| Rate for Payer: BCBS MAPPO |
$1,688.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,688.07
|
| Rate for Payer: Cash Price |
$4,225.60
|
| Rate for Payer: Cash Price |
$4,225.60
|
| Rate for Payer: Cofinity Commercial |
$2,430.82
|
| Rate for Payer: Cofinity Commercial |
$2,262.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,688.07
|
| Rate for Payer: Healthscope Commercial |
$2,025.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,025.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,772.47
|
| Rate for Payer: Nomi Health Commercial |
$2,025.68
|
| Rate for Payer: PACE SWMI |
$1,688.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,688.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,433.30
|
| Rate for Payer: Priority Health Medicare |
$1,688.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,688.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,688.07
|
| Rate for Payer: UHCCP DNSP |
$1,688.07
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Facility
|
OP
|
$4,652.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$1,860.80 |
| Max. Negotiated Rate |
$4,652.00 |
| Rate for Payer: Aetna Commercial |
$4,186.80
|
| Rate for Payer: Aetna Medicare |
$2,326.00
|
| Rate for Payer: ASR ASR |
$4,512.44
|
| Rate for Payer: ASR Commercial |
$4,512.44
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,809.52
|
| Rate for Payer: BCN Commercial |
$3,606.70
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$4,372.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,721.60
|
| Rate for Payer: Healthscope Commercial |
$4,652.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,512.44
|
| Rate for Payer: Mclaren Commercial |
$4,186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,954.20
|
| Rate for Payer: Nomi Health Commercial |
$3,814.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,076.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,261.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,093.76
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 44202
|
| Min. Negotiated Rate |
$1,342.87 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$1,799.45
|
| Rate for Payer: Aetna Medicare |
$1,342.87
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,342.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.87
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,933.73
|
| Rate for Payer: Cofinity Commercial |
$1,799.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.87
|
| Rate for Payer: Healthscope Commercial |
$1,611.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,611.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,410.01
|
| Rate for Payer: Nomi Health Commercial |
$1,611.44
|
| Rate for Payer: PACE SWMI |
$1,342.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,342.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.87
|
| Rate for Payer: UHCCP DNSP |
$1,342.87
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Facility
|
IP
|
$4,652.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$3,023.80 |
| Max. Negotiated Rate |
$4,652.00 |
| Rate for Payer: Aetna Commercial |
$4,186.80
|
| Rate for Payer: ASR ASR |
$4,512.44
|
| Rate for Payer: ASR Commercial |
$4,512.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,790.91
|
| Rate for Payer: BCN Commercial |
$3,606.70
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$4,372.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,721.60
|
| Rate for Payer: Healthscope Commercial |
$4,652.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,512.44
|
| Rate for Payer: Mclaren Commercial |
$4,186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,954.20
|
| Rate for Payer: Nomi Health Commercial |
$3,814.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,093.76
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$1,342.87 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$1,799.45
|
| Rate for Payer: Aetna Medicare |
$1,342.87
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,342.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.87
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,933.73
|
| Rate for Payer: Cofinity Commercial |
$1,799.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.87
|
| Rate for Payer: Healthscope Commercial |
$1,611.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,611.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,410.01
|
| Rate for Payer: Nomi Health Commercial |
$1,611.44
|
| Rate for Payer: PACE SWMI |
$1,342.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,342.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.87
|
| Rate for Payer: UHCCP DNSP |
$1,342.87
|
|
|
PR LAPS ESOPHAGEAL LENGTHENING ADDL
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 43283
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$219.18 |
| Rate for Payer: Aetna Commercial |
$203.96
|
| Rate for Payer: Aetna Medicare |
$152.21
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCBS MAPPO |
$152.21
|
| Rate for Payer: BCN Medicare Advantage |
$152.21
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$219.18
|
| Rate for Payer: Cofinity Commercial |
$203.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.21
|
| Rate for Payer: Healthscope Commercial |
$182.65
|
| Rate for Payer: Healthscope Whirlpool |
$182.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.82
|
| Rate for Payer: Nomi Health Commercial |
$182.65
|
| Rate for Payer: PACE SWMI |
$152.21
|
| Rate for Payer: PHP Medicare Advantage |
$152.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health Medicare |
$152.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.21
|
| Rate for Payer: UHC Medicare Advantage |
$152.21
|
| Rate for Payer: UHCCP DNSP |
$152.21
|
|
|
PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
|
Professional
|
Both
|
$2,403.00
|
|
|
Service Code
|
HCPCS 43279
|
| Min. Negotiated Rate |
$961.20 |
| Max. Negotiated Rate |
$1,793.75 |
| Rate for Payer: Aetna Commercial |
$1,669.18
|
| Rate for Payer: Aetna Medicare |
$1,245.66
|
| Rate for Payer: BCBS Complete |
$961.20
|
| Rate for Payer: BCBS MAPPO |
$1,245.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,245.66
|
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cofinity Commercial |
$1,793.75
|
| Rate for Payer: Cofinity Commercial |
$1,669.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,245.66
|
| Rate for Payer: Healthscope Commercial |
$1,494.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,307.94
|
| Rate for Payer: Nomi Health Commercial |
$1,494.79
|
| Rate for Payer: PACE SWMI |
$1,245.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,245.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,561.95
|
| Rate for Payer: Priority Health Medicare |
$1,245.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,245.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,245.66
|
| Rate for Payer: UHCCP DNSP |
$1,245.66
|
|
|
PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$2,228.00
|
|
|
Service Code
|
HCPCS 58662
|
| Min. Negotiated Rate |
$686.08 |
| Max. Negotiated Rate |
$1,448.20 |
| Rate for Payer: Aetna Commercial |
$919.35
|
| Rate for Payer: Aetna Medicare |
$686.08
|
| Rate for Payer: BCBS Complete |
$891.20
|
| Rate for Payer: BCBS MAPPO |
$686.08
|
| Rate for Payer: BCN Medicare Advantage |
$686.08
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cofinity Commercial |
$987.96
|
| Rate for Payer: Cofinity Commercial |
$919.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.08
|
| Rate for Payer: Healthscope Commercial |
$823.30
|
| Rate for Payer: Healthscope Whirlpool |
$823.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.38
|
| Rate for Payer: Nomi Health Commercial |
$823.30
|
| Rate for Payer: PACE SWMI |
$686.08
|
| Rate for Payer: PHP Medicare Advantage |
$686.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health Medicare |
$686.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.08
|
| Rate for Payer: UHC Medicare Advantage |
$686.08
|
| Rate for Payer: UHCCP DNSP |
$686.08
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$1,726.00
|
|
|
Service Code
|
HCPCS 43774
|
| Min. Negotiated Rate |
$690.40 |
| Max. Negotiated Rate |
$1,348.83 |
| Rate for Payer: Aetna Commercial |
$1,255.16
|
| Rate for Payer: Aetna Medicare |
$936.69
|
| Rate for Payer: BCBS Complete |
$690.40
|
| Rate for Payer: BCBS MAPPO |
$936.69
|
| Rate for Payer: BCN Medicare Advantage |
$936.69
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cofinity Commercial |
$1,348.83
|
| Rate for Payer: Cofinity Commercial |
$1,255.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.69
|
| Rate for Payer: Healthscope Commercial |
$1,124.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,124.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.52
|
| Rate for Payer: Nomi Health Commercial |
$1,124.03
|
| Rate for Payer: PACE SWMI |
$936.69
|
| Rate for Payer: PHP Medicare Advantage |
$936.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.90
|
| Rate for Payer: Priority Health Medicare |
$936.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$936.69
|
| Rate for Payer: UHC Medicare Advantage |
$936.69
|
| Rate for Payer: UHCCP DNSP |
$936.69
|
|
|
PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$4,667.00
|
|
|
Service Code
|
HCPCS 43775
|
| Min. Negotiated Rate |
$1,079.76 |
| Max. Negotiated Rate |
$3,033.55 |
| Rate for Payer: Aetna Commercial |
$1,446.88
|
| Rate for Payer: Aetna Medicare |
$1,079.76
|
| Rate for Payer: BCBS Complete |
$1,866.80
|
| Rate for Payer: BCBS MAPPO |
$1,079.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.76
|
| Rate for Payer: Cash Price |
$3,733.60
|
| Rate for Payer: Cash Price |
$3,733.60
|
| Rate for Payer: Cofinity Commercial |
$1,554.85
|
| Rate for Payer: Cofinity Commercial |
$1,446.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.76
|
| Rate for Payer: Healthscope Commercial |
$1,295.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,295.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.75
|
| Rate for Payer: Nomi Health Commercial |
$1,295.71
|
| Rate for Payer: PACE SWMI |
$1,079.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,033.55
|
| Rate for Payer: Priority Health Medicare |
$1,079.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.76
|
| Rate for Payer: UHCCP DNSP |
$1,079.76
|
|
